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The evolution of anticoagulant drugs: How did Prasugrel surpass its predecessors?
Antiplatelet drugs play a vital role in the management of acute coronary syndrome (ACS) and in preventing thrombotic-related diseases. This type of drug, especially adenosine diphosphate (ADP) receptor inhibitors, works by antagonizing the P2Y12 receptor on platelets, preventing ADP from binding to it, thereby preventing platelet aggregation and combating thrombosis. Since the advent of the first-generation drug Ticlopidine, there has been significant progress in this field. Among them, the birth of Prasugrel as a third-generation drug has attracted widespread attention.
The history of antiplatelet therapy dates back to the 1970s, when researchers began exploring drugs that target platelet aggregation, opening up a new treatment path.
Evolution of ADP receptor inhibitors
From Ticlopidine to ClopidogrelSince Ticlopidine entered the market, due to its frequent adverse reactions, the academic community has turned its attention to developing new drugs. Clopidogrel was launched in 1998. Although it has shown significant improvements in clinical efficacy, about 30% of patients still develop resistance to it, which is due to the influence of CYP2C19 genotype.
The emergence of PrasugrelPrasugrel was launched in 2009 and was seen as a solution to overcome the shortcomings of previous drugs. Unlike Clopidogrel, Prasugrel's metabolic pathway ensures that it is not affected by the CYP2C19 genotype, showing its higher efficacy and faster onset of action, making Prasugrel one of the preferred drugs for patients with acute coronary syndrome .
Many studies have shown that Prasugrel is superior to Clopidogrel in reducing the risk of myocardial infarction and stent thrombosis.
New generation of ADP receptor inhibitors
The rise of Ticagrelor and CangrelorAs the demand for antiplatelet therapies continues to rise, non-thiidine drugs such as Ticagrelor and Cangrelor have emerged. These drugs can act directly on the P2Y12 receptor without metabolic activation, thus having a faster duration of action and duration. These new-generation drugs are designed to improve efficacy while minimizing the safety deficiencies of traditional antiplatelet drugs.
Clinical Application and Prospects
In clinical use, Prasugrel has been shown to help reduce the risk of cardiovascular events compared with other drugs, particularly in patients with acute coronary syndrome. The dosage of Prasugrel is 60 mg loading dose and 10 mg daily maintenance dose, which is also convenient for clinical implementation.
For patients who require interventional treatment, the optimal choice of antiplatelet therapy will impact their recovery and long-term health outcomes.
With the advent of more new antiplatelet drugs, there are more and more treatment options available clinically. However, these new drugs also face challenges such as higher risk of bleeding. In the future, how to balance efficacy and safety will still be an important issue that needs to be explored in clinical practice?
